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Pharmacy

  • We use the state of West Virginia's Preferred Drug List (PDL).
  • Some drugs have quantity limits set by the state.
Coverage of over-the-counter (OTC) medicines*

UniCare members get certain over-the-counter medicines filled through their pharmacy benefit. It's easy!

All you have to do is:

  1. Go to your provider.
  2. Ask for a prescription.
  3. Take that prescription to a participating network pharmacy.
  4. Show the prescription and your ID card.

Preferred Drug List

*OTC medicines must be on the state's preferred drug list (PDL) or covered OTC list. Usual prescription copays apply. View Preferred Drug List.

You can email and ask us for an exception.

Drug Interactions and Side Effects

Learn more about drug interactions or side effects on the Express Scripts Drug Information website.

Pharmacy Benefits Manager

UniCare uses Express Scripts as your Pharmacy Benefit Manager.

Copays

Allowed Charge of Drug/Copay

  • Total cost of drug
  • $0.00-$5
  • $5.01-$10
  • $10.01-$25
  • $25.01-$50
  • $50.01 and above
  • Copayment
  • $0
  • $0.50
  • $1
  • $2
  • $3

Copay Exemptions

  • Members who have met their household maximum limit for the cost-sharing obligations per calendar quarter
  • Pregnant women including pregnancy-related services up to 60 days post-partum
  • Children under age 21
  • Native American and Alaskan natives
  • Intermediate Care Facility or Mental Retardation Services
  • Preventive services for children under age 18
  • Individuals in nursing homes
  • Members in hospice
  • Medicaid Waiver services or covered through the Breast and Cervical Cancer Treatment Program
  • Family planning and emergency services
  • Diabetic testing supplies, syringes, and needles
  • BMS-approved home infusion supplies
  • 3-day emergency supplies

Maximum Out of Pocket

  • Tier
  • Tier 1
  • Tier 2
  • Tier 3
  • Gross quarterly income range
  • $0-$1,436.25
  • $1,436.26-$2,872.50
  • $2,872.51 and above
  • Copay maximum
  • $8
  • $71
  • $143
How to Choose

Is your provider in
our network?

 

I have questions about my UniCare benefits.

Call the Customer Care Center at 1-800-782-0095, Monday through Friday from 8 a.m. to 6 p.m.